[Joan M]

Jean,

My situation was a dilemma which led to the FISH test, and it also points out the extent of variation in test results.

My IHC came back 3+ and I took Herceptin off-label. But two months after my bc surgery in my right breast and after two cycles of A/C, I noticed a small pea-sized bump in my reconstructed breast, which when removed turned out to be the same breast cancer.

Since it was never tested for ER/PR or HER2, a year later I asked for that and it tested ER-/PR-, like the original tumor, but HER2 2+, as per IHC. And when it was put to the FISH test, it tested negative.

My onc suggested I have both tumors tested in a major lab, so I sent to Sloan-Kettering. The results were IHC 2+ and the FISH test was borderline (2.0). The onc there considered it borderline positive, and said it's better to err on the safe side. I had finished Herceptin already and he said it was good that I got it.

The pea-sized bump has never been a problem. It seemed to be the result of either the skin-sparing mastectomy I had to faciliate the DIEP flap reconstruction or perhaps seeding from the core biopsy since it occurred just beneath the scar from the biopsy.

It's occurrence also seemed to indicated that I was not responding to A/C since I was already two cycles into the treatment.

My own theory though is that the chemo did not reach that area due to scar tissue from the mastectomy, reconstruction and removal of lymph nodes because although all my hair fell out everywhere, it never really fell out under that arm pit. Go figure.

I then had radiation right away rather than to wait until the end of the A/C and Taxol that followed.

Also, Hopeful's explanation is generally the way it's done. So if a woman is denied the FISH test, it may be because she was IHC3+.